Improving Primary Health Care Data With ICPC-3: From a Medical to a Person-Centered Perspective.

The World Organization of Family Doctors (WONCA) developed the third edition of the International Classification of Primary Care (ICPC-3) to support the shift from a medical perspective to a person-centered perspective in primary health care. The previous editions (ICPC-1 and ICPC-2) allowed description of 3 important elements of health care encounters: the reason for the encounter, the diagnosis and/or health problem, and the process of care. The ICPC-3 adds function-related information as a fourth element, thereby capturing most parts of the encounter in a single practical and concise classification. ICPC-3 thus has the potential to give more insight on patients' activities and functioning, supporting physicians in shifting from a strict medical/disease-based approach to care to a more person-centered approach. The ICPC-3 is also expanded with a new chapter for visits pertaining to immunizations and for coding of special screening examinations and public health promotion; in addition, it contains classes for programs related to reported conditions (eg, a cardiovascular program, a heart failure program) and can accommodate relevant national or regional classes. Classes are selected based on what is truly and frequently occurring in daily practice. Each class has its own codes. Less frequently used concepts pertaining to morbidity are captured as inclusions within the main classes. Implementation of the ICPC-3 in an electronic health record allows provision of meaningful feedback to primary care, and supports the exchange of information within teams and between primary and secondary care. It also gives policy makers and funders insight into what is happening in primary care and thus has the potential to improve provision of care.

Barriers integrating dedicated software for quality management in pain centres.

OBJECTIVES: Explore the feasibility of integrating a dedicated pain centre information system as part of a quality management network with a number of different Hospital Information Systems. MATERIAL & METHODS: A systematic approach integrating and implementing the system in 15 selected hospital organisations (a nationwide 15% non-random sample). RESULTS: Hospitals have widely varying policies on integration and implementation of additional clinically required 3rd party software. Financial and organisational constraints are considerable. Partial data integration could be realised in one third of the hospital organisations within the project timeframe. Linking with various types of Hospital Information Systems from the same or different vendors caused no technical difficulties. The total effort required, however, varies considerably; different versions of a HIS of the same vendor require substantial additional effort. IT departments hardly use standard rules to accept this type of systems, causing substantial increases in completion time for installation. CONCLUSIONS: Although it is feasible to integrate a local departmental system as required (download of general patient, provider and referrer data basically, and also upload of certain data) the workload of scaling to the national level is considered far beyond what is reasonable for a national quality management network for pain. Alternatives for recording and capturing data (which comply with the requirements of the national system) are currently being explored.

An Ontology driven collaborative development for biomedical terminologies: from the French CCAM to the Australian ICHI coding system.

The CCAM French coding system of clinical procedures was developed between 1994 and 2004 using, in parallel, a traditional domain expert's consensus method on one hand, and advanced methodologies of ontology driven semantic representation and multilingual generation on the other hand. These advanced methodologies were applied under the framework of an European Union collaborative research project named GALEN and produced a new generation of biomedical terminology. Following the interest in several countries and in WHO, the GALEN network has tested the application of the ontology driven tools to the existing reduced Australian ICHI coding system for interventions presently under investigation by WHO to check its ability and appropriateness to become the reference international coding system for procedures. The initial results are presented and discussed in terms of feasibility and quality assurance for sharing and maintaining consistent medical knowledge and allowing diversity in linguistic expressiveness of end users.

The development of CCAM: the new French coding system of clinical procedures.

A new French coding system of clinical procedures, the Classification Commune Des Actes Medicaux (CCAM), has been developed at the turn of the millennium (between 1996 and 2001). Two methodologies were used: a traditional domain-experts consensus method, and an artificial-intelligence-based semantic representation. An economic evaluation of clinical procedures was also undertaken for the rating for fee-for-service payment. We present the methodologies used and stress how the European Union research project, 'European Consortium, Generalised Architecture for Languages, Encyclopaedias and Nomenclatures in Medicine' (GALEN), facilitated the sharing and maintaining of consistent medical knowledge. This country case study highlights the significant cost to individual countries in developing their own classifications in isolation. It also demonstrates the benefits of contributing to international efforts such as GALEN that enable harmonisation, yet still allow for diversity.